Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: Conventional laryngoscopy versus an intubating laryngeal mask airway

Abstract

OBJECTIVES:We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients.METHODS:Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded.RESULTS:The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33±10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90±3750 and 13936.76±2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61±3413 and 11937.52±3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups.CONCLUSION:The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

The Effect of the Open and Closed System Suctions on Cardiopulmonary Parameters: Time and Costs in Patients Under Mechanical Ventilation

“…However, it is in contrast to the result of Lee et al (9). Airways suctioning is an invasive procedure and can result in increased blood pressure as well as heart rate through sympathetic system stimulation mechanisms (29). It can be noted that in similar studies, the selected subjects had various modes of ventilation and the patients did not have similar PEEP while in the present study, all the subjects were under SIMV mode and their PEEP was fixed as 5 cm H 2 O in ventilator.…”

Haemodynamic Response to Tracheal Intubation: A Comparison of Direct Laryngoscopy, Intubating Laryngeal Mask Airway and Lightwand Guided Intubation Techniques

“…[18] also found significant increase in heart rate and blood pressure in both DLS and ILMA groups after intubation, but quantity of these changes was similar in both groups. In contrast to above studies Sener et al [19] found ILMA aided intubation to have higher sympathetic response when compared to DLS in 42 patients with controlled hypertension. They found intubation with DLS was accompanied by a smaller increase in blood pressure and rate pressure product at 1 and 2 min following intubation than with the ILMA method.…”

Perbedaan Tekanan Darah, Laju Jantung dan Rate Pressure Product (RPP) Pada Pemberian Lidokain 1,5 Mg/Kgbb Intravena Sebelum Intubasi Dibandingkan Pemasangan Laryngeal Mask Airway (LMA)

“…Laringoskopi dan intubasi ini selain dapat menyebabkan trauma, juga dapat menimbulkan gejolak kardiovaskuler berupa peningkatan tekanan darah, peningkatan laju jantung dan disritmia. 2,3 Hal ini disebabkan oleh respon aktivitas simpatis dan pelepasan katekolamin akibat rangsangan pada daerah laring, trakea, karina dan bronkus. 4,5,6 Pada orang sehat respon ini sebagian besar dapat ditoleransi, tetapi lidokain, fentanyl, remifentanil, alfentanil, penyekat beta, nifedipin, klonidin dan diltiazem.…”